Residents Work Less, So Boston Hospitals Staff Up

If you want to take the pulse of academic medicine, put your finger on Boston, home to three med schools and an archipelago of teaching hospitals training some 4,000 medical residents.

So this morning’s Boston Globe grabbed our attention with an update on teaching hospitals’ continuing struggle to adapt to four-year-old rules limiting residents’ work hours.

Boston hospitals are hiring more residents, shifting some work to more-experienced doctors and improving patient hand-offs when residents punch out. Preliminary research cited in the story suggests medication errors and other problems may be declining because residents are less fatigued than they used to be. The work limits are 80 hours a week and 24 hours at a stretch, which can be extended to 30 hours in some cases.

But, as a survey published last month (not to mention the comments on our post on the survey) showed, many doctors see the rules as a two-edged sword.

Hasan Bazari, who runs Mass General’s internal medicine residency program, explains the dilemma. The new rules “have basically transformed residency from an obstacle course to something that’s actually sustainable and enriching. But at the end of the day we still have the question of what is the right mix of experiences and exposures to train a doctor. And if you cut back work hours, can you still train people in the same period of time?”

Some residents may not be adhering to the rules. While a study by the group that accredits residency programs found that only 3% of residents worked more hours than the rules allowed, Harvard sleep researchers found that 80% of residents they surveyed worked excess hours.

Comments (5 of 19)

Good to see "resident's" perspective on this, which ties in nicely with the majority view above favoring the 80 hour cap. "Resident," I'm glad you are operating in saner times. :-)

9:30 pm August 6, 2007

resident wrote :

The 80 hour rule means 80 hours a week "averaged" over 4 weeks, which means some weeks we work just as many hours as the good ol days. The 80 hour rule is the resident schedule on paper, it doesn't count the time a go in after my kids are asleep to do paper work and dictate and call patients, etc. Plus, the work hours are spread out over the course of a residency. While years ago, in primary care residencies, the work "let up" somewhat after the first or second year--now it doesn't seem to be. Besides, when I am on my death bed, it won't matter how many hours I worked. It will matter how much time I spent with my kids. All the thrice married attendings who complain about the new work duty hours should ask their 381 variations of stepkids if it is a better rule.

5:36 pm August 6, 2007

Sandip Madan wrote :

Boston Hospitals hiring more residents as a result of the 80 hour cap? I wonder where those extra residents are coming from. This is not a free labor market for residents. The number of residents allowed to be taken in nationally has been fixed by the ACGME and the RRCs. So if Boston is hiring more residents, some other place in the US is forced to hire less...

On the 80 hour weekly cap for residents, I'm glad the merits are appreciated even by the older school doctors like WMK. For all the cogent reasons advanced above, most folks support this sensible cap. My question to holdouts like RRL is: How many hours a week do you work on average currently? Honestly. (To be fair, RRL may be at one end of the curve, so the question should more appropriately be about the hours worked by an average physician.)

It's worth noting that different specialties place different demands on resident. Internal medicine, surgery, ob-gyn ... these are all associated with 80-100 hour work weeks. Neurology (which I'm familiar with) and other so-called "lifestyle specialties" have much saner hours after residents complete PGY1. Of course, these specialists work less hours IN GENERAL, but that's why medical students are opting out of primary care in droves - ESPECIALLY considering the salary difference. I agree that more data is always a good thing, but I truly believe that saner hours equal more alert, more compassionate, more satisfied residents who ENJOY their jobs (something you hardly ever hear in primary care) and in turn provide better patient care.

4:53 pm August 6, 2007

RRL wrote :

Patient safety has to come first . . . Duh. Show me the data demonstrating that this system is safer. I'm sure the number of mistakes has more to do with time of year (much higher propensity in July when new interns/residents start) than anything else.